Knee MRI Interpretation and SS Programming

[od1]

Hi All,

I had a MRI as a result of a knee injury and before I talk with the doc, I thought I'd see if anyone here has some general advice or experiences to share with a similar injury.

I sprained my right knee last August, couldn't put weight on it (was on crutches for a couple of weeks) and it felt better by November where I continued with the SS program. Then, in January I took a couple of baseball bat swings and some time after I noticed that the knee felt unstable and there was occasional popping while walking (I wasn't actually sure if the swings re-injured the knee). A couple of weeks later it felt 90% healed, and I did a pre season baseball workout, and it seemed like batting practice irritated the area again (seems like the back leg twisting motion aggravates or re-injures it).

The knee has a bit of tenderness with weight on it (like when walking) and still feels unstable. I'm continuing to squat without any pain while squatting, but it is tender the next day (the surrounding muscles seem to tighten up too). Based on the MRI results and symptoms, I'm wondering if squatting or any of the novice SS programming lifts would be safe to continue.

X-rays didn't show any issues.

Here's the MRI report:

IMPRESSION:

1. Unstable radial tear of the posterior horn root attachment of the medial meniscus associated with peripheral subluxation.

2. Peripheral medial femoral condyle chondral thinning. No evidence for fracture.

3. Mucoid degeneration of the ACL with cystic traction changes at the ACL footprint. No evidence for tear.

4. Synovitis and large joint effusion. 3 cm leaking popliteal cyst with inflammatory change extending along the superficial surface of the medial gastrocnemius.

FINDINGS:

Ligaments: Mucoid degeneration of the ACL with cystic traction changes of the tibia at the ACL footprint. No evidence for tear. Mild PCL degeneration without evidence for tear. Thickening and scarring of the MCL consistent with remote trauma. No acute change and no evidence for tear. Lateral ligaments are intact.

Medial compartment: Unstable radial tear of the posterior horn root attachment of the medial meniscus seen on coronal image #7. Associated with peripheral subluxation. Partial to full-thickness chondral loss of the peripheral central weightbearing surface of the medial femoral condyle.

Lateral compartment: The lateral meniscus is intact. No evidence for tear. The hyaline articular cartilage surfaces are intact.

Patellofemoral joint: Mild chondral fissuring of the lateral patellar facet. Mild chondral thinning of the central femoral trochlea. No evidence for fracture. Tendons are intact.

Osseous structures: Cystic traction changes of the tibia at the ACL footprint. No evidence for fracture or AVN. No evidence for bone destructive or erosive change.

General: Synovitis and large joint effusion. 3 cm leaking popliteal cyst with inflammatory change extending along the superficial surface of the medial gastrocnemius.

[Mark Rippetoe]

How old are you? Height/weight?

[od1]

52, 5'10", 205lbs

[Railbob1776]

Any news on this? Have you tried squatting or laying off?

[od1]

I continued squatting, 3x5 90kg last workout, so pretty light weight. Seems like it aches more after a two day lay off than it does during or after workout days. Scheduled to have an MRI review with doc next week. Overall it still feels unstable, so no baseball activities.

Incidentally, as I share the story and people share me their stories, I'm amazed at how many people have had knee surgeries to repair the meniscus. Some seem to heal with PT, but lifestyle among all of those folks varies.

[Railbob1776]

You may want to try doing some horizontal leg presses if squatting is too painful. As a guy with shitty knees myself, I used the HLP exclusively for a while before trying to barbell squat again. The HLP obviously isn't a full body movement like the squat but it is helpful if you have a knee pathology because it allows for you to adjust so many variables so quickly and easily to make things pain free and it prevents the knees from going over the toes. It might be a good temporary substitute until you figure out what's going on. I'd be interested in what the diagnosis it, let us know. Good luck.

[Mark Rippetoe]

What is a "horizontal leg press"?

[Railbob1776]

Just what it sounds like. Like I said, it's not a substitute for a squat but if someone cannot squat due to knee pain, it's a good way to still train legs and the knees through a full range of motion without the same compressive force. I was able to perform this movement with zero pain at a time when barbell squatting was too painful and now I'm back to building up my barbell squat.

[Mike Kelly]

What is a "horizontal leg press"?

I'm sure Will can speak to this better than I can but it's a standard piece of equipment in most PT clinics and (sadly), I believe in most Planet Fitnessesque venues. It uses some sort of tension devices for resistance. For the ones I was in it was a series of detachable springs. In the clinics I have gone to it was very effective, FOR ME, very early on in my recovery but of limited use generally. Its greatest utility as far as I can tell is that allows mobility to be pushed actively when the eccentric phase is impossible to truly load perpendicular to the earth and the clouds.

I had a total evulsion of my quad. It re-evulsed 3-5 days after surgery leaving only (I think from memory shame on me) the rectus femoralis attached but that was not acknowledged/recognized for four months. Coming out of both those surgeries, without this machine my recovery ceiling/window would have been altered and not for the better. The mobility has to be pushed on it though. In ways that are not pleasant to the senses. In most clinics (I would guess) if you aren't aggressive and a develop a relationship with your PT they tend to take it easy on you. It was not used (for me) as a long term substitute for the real stuff (box squats, real squats, DATCBPs etc.).

My situation was (I think) pretty unique. As for the use/application for "od1" I obviously cannot speak to that.

Good luck with your recovery!

[Martin Shenfield]

Having used one for quite a while at physiotherapy after my leg fracture I think the pin loaded horizontal leg press is not that useful. Even in a rehab setting.

Once I could squat I did, before that I was doing super light rehab exercises or trying to pedal a bike. The leg press stage was in between them and I now think I could have just been working on a rack pull/deadlift first and building strength there and then go straight to either a 45 degree leg press or to a squat to a box like I did.

I feel like that would be more useful, easier to incrementally load and possibly a faster return than a pin loaded machine.